- Smartphone-delivered behaviour therapy for insomnia (BI) produced greater ISI reductions at week 6 than health-information and behavioural activation comparators.
- BI also yielded larger short-term improvements in depressive and anxiety symptoms versus HI, with comparable effects to BA; mood benefits attenuated by week 26.
- Combining BA with BI provided no added benefit over BI alone; findings are exploratory and require replication before population-level recommendation.
Internet Interv. 2026 Sep 25;46:101009. doi: 10.1016/j.invent.2026.101009. eCollection 2026 Dec.
ABSTRACT
BACKGROUND: Insomnia is common and often coexists with depression and anxiety. Digital delivery can expand access, yet few trials have compared insomnia-focused behavioral interventions with strong active controls under standardized conditions.
OBJECTIVES: To examine whether a smartphone-delivered behavior therapy for insomnia (BI) improves insomnia more than a mood-focused behavioral activation (BA) module or a health-information (HI) comparator, and whether combining BI with BA (BA+BI) adds benefit.
METHODS: We conducted a secondary analysis of the multi-arm RESiLIENT randomized controlled trial among adults from the general population with elevated insomnia (Insomnia Severity Index (ISI) ≥8). Participants were assigned to BI, BA+BI, BA, or HI, each self-guided over six weeks. The primary outcome was ISI change at weeks 6 and 26, analyzed using mixed-effects models. Depressive (PHQ-9) and anxiety (GAD-7) symptoms were secondary outcomes. Analyses followed a modified intention-to-treat approach (≥1 post-baseline assessment).
RESULTS: At week 6, BI reduced insomnia severity more than HI (ES: -0.43, CI: -0.58 to -0.28) and BA (ES: -0.26, CI: -0.42 to -0.11); BA also exceeded HI (ES: -0.16, CI: -0.32 to -0.01). Adding BA to BI gave no benefit over BI alone (vs HI, ES: -0.30, CI: -0.45 to -0.14). BI reduced depressive (ES: -0.44, CI: -0.59 to -0.29) and anxiety symptoms (ES: -0.27, CI: -0.42 to -0.12) more than HI, and matched BA (each ES: 0.05, CI: -0.10 to 0.20). At week 26, ISI differences persisted but PHQ-9 and GAD-7 differences attenuated.
CONCLUSIONS: This exploratory, hypothesis-generating analysis associated a focused smartphone-delivered sleep intervention with durable improvements in insomnia severity and mood. Replication in independent samples, and confirmation in trials recruiting participants with elevated insomnia, is required before recommendation at scale.
PMID:42889802 | PMC:PMC13671329 | DOI:10.1016/j.invent.2026.101009
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